| 摘要: | 本研究旨在發展「強迫症照顧者」之「負荷量表」，作為臨床專業人員評估之工具，並提供專業人員處遇計畫之參考，以幫助需要協助的強迫症病患照顧者。經國、內外相關文獻探討後建立量表架構，並進行編題，再經過專家審查後建立預試量表；接著，依據預試結果進行項目分析以建立正式量表，並進行正式施測，最後建立信、效度。其中，將使用「立意取樣」之方法，訪問120位心理諮商所、心理治療所及醫院精神科門診的強迫症患者之家屬為研究參與對象。研究工具為自編之「強迫症患者照顧負荷量表」、「中文版耶魯—布朗強迫症量表（Y-BOCS）」、「臺灣簡明版世界衛生組織生活品質量表」、「台灣人憂鬱症量表」、與「修訂情境與特質焦慮量表的特質焦慮量表部分」。
本研究結果如下：一、「強迫症患者照顧負荷量表」題數共計32題，分為「身體負荷」、「心理負荷」、「社交負荷」、「家庭負荷」及「治療負荷」五個分量表，各向度底下包含若干實際內涵。二、信度考驗：（1）內部一致性信度：「強迫症患者照顧負荷量表」的Cronbach’s α係數為.962，身體負荷分量表的Cronbach’s α係數為.910，心理負荷分量表的Cronbach’s α係數為.900，社交負荷分量表的Cronbach’s α係數為.896，家庭負荷分量表的Cronbach’s α係數為.874，治療負荷分量表的Cronbach’s α係數為.810。顯示本量表具有良好的內部一致性。（2）重測信度：本量表間隔二或四週之重測信度考驗結果顯示，總量表的重測信度為.577，身體負荷分量表為.394，心理負荷分量表為.839，社交負荷分量表為.472，家庭負荷分量表為.679，治療負荷分量表為.672，均達.05的顯著相關，顯示本量表具有時間的穩定性。三、效度考驗：（1）內容效度：量表題目經指導教授及4位專家學者根據題目所屬定義內涵進行審查，合格率高達100%，顯示本量表具有良好的內容效度。（2）效標關聯效度：本量表與「台灣簡明版世界衛生組織生活品質問卷」相關係數介於-.314至-.624之間；與「台灣人憂鬱量表」相關係數介於.468至.562之間；與「修訂情境與特質焦慮量表-特質焦慮部分」相關係數介於.409至.591之間，大部分皆達.05或.01顯著水準，顯示本量表具有同時效度。（3）建構效度：本研究利用因素分析法考驗量表的因素內涵，結果大致符合原設計構念。四、照顧現況與影響照顧負荷之因素：本研究之照顧者以女性照顧者佔多數，不少照顧者是患者的雙親。照顧者大多會配合患者的症狀。強迫症患者的男女比例大致相當，平均發病年齡為22歲，平均罹病時間約為9年。以心理負荷程度最高，治療負荷次之，家庭負荷最低。影響照顧負荷的因素有：女性照顧者、家庭氣氛、照顧者的健康狀況、家庭支持程度、機構支持程度。且患者的強迫症嚴重程度越嚴重，照顧者的負荷越大。
最後，本研究根據研究結果提出建議，供實務工作及未來研究之參考。
The purpose of the study is to develop a burden scale for caregivers of obsessive-compulsive disorder patients. Professions could use the scale to understand the degree of burden of caregivers, and the result could be a reference of intervention plan. The structure of the scale is based on related literatures, and then items are established. After examining by experts, the pre-trail scale is used to survey 60 caregivers. The formal scale is established after item analysis of the result of pre-trail, and the reliability and validity are examined. 120 subjects are chosen from counseling and psychotherapy clinic and from psychiatric clinic by means of purposive sampling. Other research tools include Chinese version of the Yale-Brown Obsessive-Compulsive Scale, WHOOQOL-BREF Taiwan Version, Taiwanese Depression Questionnaire, and State Trait Anxiety Inventory. The results of the study are as follows:
1.The Burden Scale on Caregivers of Obsessive-Compulsive Disorder Patients (BSOCOOCDP) has 32 items and 5 sub-scales: physical burden, psychological burden, social burden, family burden, and treatment burden. There are several concrete content in every sub-scales.
2.Reliability: (1) Internal consistency reliability: Cronbach’s α of BSOCOOCDP is .962, physical burden sub-scale is .910, psychological burden sub-scale is .900, social burden sub-scale is .896, family burden sub-scale is .874, and treatment burden sub-scale is .810. BSOCOOCDP has good internal consistency reliability. (2) Test-Retest reliability: after 2 or 4 weeks retest, values of the correlation of BSOCOOCDP is .577, physical burden sub-scale is .394, psychological burden sub-scale is .839, social burden sub-scale is .472, family burden sub-scale is .679, and treatment burden sub-scale is .672. All scales reach .05 significantly correlated level. BSOCOOCDP has good longitudinal stability.
3.Validity: (1) Content validity: items are examined by adviser and 4 experts, and all items are accepted, which means BSOCOOCDP has good content validity. (2) Criterion-related validity: values of the correlation between BSOCOOCDP and WHOOQOL-BREF Taiwan Version are -.468 to -.624, .468 to .562 with Taiwanese Depression Questionnaire, and .409 to .591 with State Trait Anxiety Inventory. All scales reach .05 or .01 significantly correlated level. BSOCOOCDP has current validity. (3) Construct validity: The result of factor analysis meets the designed structure.
4.Current situation of caregivers and significant factors of caregiver burden: women caregivers are majority in the study, and many caregivers are patients’ parents. Most of caregivers would submit patients’ demand. Numbers of men and women patients are equal. The average age of OCD onset is 22, and the average duration of illness is 9 years. The severest burden is psychological burden, then treatment burden, and family burden is the least. Significant factors of caregiver burden are as follows: women caregivers, home climate, health of caregivers, support of family, and support of institutions. The more patients’ OCD severity are, the more burden caregivers have.
Finally, based on the study result and discussions, suggestions will be presented as reference for professions and future research. |
